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GI disorders Flashcards

1
Q

Which race are prone to get PUD

A

Chinese

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2
Q

What is the main cause of chronic gastritis, duodenal ulcers & gastric ulcers

A

H.pylori

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3
Q

Drugs induced ulcer bleeding

A

NSAIDs and low dose aspirin

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4
Q

State 4 management of PUD

A
  1. Proper diagnosis
  2. Treatment of acute episode
  3. Prevention of relapse
  4. Treatment of complication
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5
Q

State the causes of PUD & what dose it do

A

Stimulate gastric acid secretion

  1. NSAIDs
  2. Strain
  3. Alcohol
  4. Coffee

mucosal inflammation / injury
4. H.pylori

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6
Q

Definition of PUD

A

A group of ulcerative disorder of the upper GIT that require acid and Pepsin for its formation

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7
Q

Healthy mucosa have balance of 2 factors which are hostile factor and protective factor. What are the components of each factor?

A

Hostile factor (4)
1 NSAIDs
2 Pepsin
3 Gastric acid
4 Hpylori

Protective factor (4)
1 Bicarbonate
2 Prostaglandins
3 Mucus production
4 Blood flow to mucosa

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8
Q

5 clinical presentation of PUD

A

Abdominal pain
Abdominal fullness
Abdominal cramping
Nocturnal pain (12-3am)
Abdominal fullness
Vague discomfort
Epigastric pain

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9
Q

How to relieve pain in duodenal ulcer

A

Pain comes 1-3 hours after meals, can be relieved with foods

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10
Q

How to relieve gastric ulcer

A

Food can precipitate the pain, relieve by antacids

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11
Q

Ulcer complication

A

GI bleeding
Perforation in the peritoneal cavity
Penetration into the adjacent structure / organs
Gastric obstruction

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12
Q

Symptoms of gastric obstruction

A

NV
satiety (kenyang)
weight loss
bloating

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13
Q

Diagnostic test of PUD

Physical examination of PUD should shows?

A

Reveal epigastric tenderness

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14
Q

Diagnostic test of PUD

Hematocrit, hb and stool should shows?

A

Bleeding

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15
Q

Diagnostic test of H.pylori

A

Only recommended if there is plan of eradication of Hpylori. Can be endoscopic or non endoscopic test.

Test:
c-urea breath test
serologic antibody test
stool antigen test

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16
Q

What is the preferred non endoscopic diagnostic test

A

UBT, preferred BEFORE and AFTER treatment & non-invasive test

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17
Q

Purpose of UBT

A

Detect the presence of Hpylori that are able to convert urea (using urease) to ammonia + carbon dioxide

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18
Q

How to conduct UBT, briefly

A

Patient swallow urea tablet
lie down, 15 mins
Collect breath
Study CO2 ammount

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19
Q

How serology antibody test is done?

A

Using enzyme-linked immunosorbent assay to detect the IgG and IgA of Hpylori

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20
Q

How stool antigen test is conducted?

A

Monoclonal / polyclonal enzyme immunoassay. Negative screen = absent

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21
Q

Treatment goals of PUD

A

RELIEVE ulcer pain
HEAL ulcer
PREVENT ulcer RECURRENCE
REDUCE ulcer related complication

22
Q

Treatment goals of hpylori pud or hx of ulcer related complication

A

Eradicate the organism
Heal the ulcer
Cure the disease (w cost effective drug regimen)

23
Q

Non pharmacologic treatment of PUD

A

Eliminate or reduce psychological stress

Avoid food that cause indigestion or exacerbate ulcer symptoms (spicy food & caffeine)

Quit smoking

Avoid NSAID & aspirin (use pcm / non acetylated salicylate)

24
Q

Hpylori treatment? what therapy? Ist line therapy

A

Triple therapy

PPI
Clarithromycin
Amoxicillin / Metronidazole for 7-14 days

or give ppi (omeprazole 20-40mg daily, esome), H2RA (ranitidine 150mg BD) & mucosal protectant (sucralfate, 1g QID)

25
Q

Second line treatment for eradicate hpylori? salvage therapy

A

PPI/H2RA
Bismuth subsalicylate
Metronidazole
Clarithromycin

26
Q

2 types of IBD

A

Ulcerative colitis (continuous and uniform, involves large bowel)
Crohn’s disease (patchy inflammation)

27
Q

Cause of IBD

A

stress
medication
smoking
sleep
gut
genetic
hygiene
diet

28
Q

Physical (pathologic) differences of UC and CD

A

UC
Have ulcerated surface

CD
Have fistula
Have cobblestone surface
Have thickening of colon wall

29
Q

Clinical difference of UC CD

A

UC
Continous distribution
Fever is uncommon
No fistula
Abs pain is unusual

30
Q

Clinical presentation of UC

A

Abdominal cramping
weight loss
Frequent bowel movement, blood in stool
Blurred vision, eye pain & photophobia w ocular involvement

31
Q

Physical examination of UC

A

Hemorrhoids
Iritis, conjunctivitis w ocular movement
Dermatologic finding (eg: skin ulcer)

32
Q

Lab test of UC

A

Rise in ESR
Dec in hematocrit, hb
Leukocytosis (rise in WBC) & hypoalbumineria

33
Q

Treatment of UC (mild, moderate and severe)

A

Sulfasalazine
Mesalamine supp/ enema
Corticosteroid (prednisone/ budesonide)

34
Q

Treatment UC if fulminant (escalated quickly / severe)

A

IV Hydrocortisone 100mg 6-8hrly
if no response, IV cyclosporine 4mg/kg
If remission, oral cyclosporine + azathioprine / mercaptopurine

35
Q

Patient receiving sulfasalazine should receive?

A

Folic acid supplement, sulfa reduce FA abs

36
Q

Success of IBD therapy can be measured by?

A

Pt complaint
Direct physical examination
Sign and symptoms
QOL measures
History and physical exam

37
Q

Assessment tool of UC

A

stool frequency
presence of blood in stool
mucosa in endoscopy

38
Q

Definition of constipation

A

< 3 stools / week (women)
< 5 stools/ week (men)
>3 days w/o bowel movement
feeling of incompleteness / difficult stool pasage

39
Q

Pathophysiology of constipation

A

Primary: no identifiable cause
Secondary: drugs, lifestyle or medical disorders

40
Q

example of drugs induced chronic constipation

A

opiods
antacids (contain Al)
Amitriptyline
CCD
diuretics
anticonvulsant (pheytoin)

41
Q

Condition causes constipation

A

IBS
DM
Chron’s disease
Diverticulitis
Hypothyroidism
Colon cancer

42
Q

Treatment of constipation

A

dietary fiber : wheat bran, fruits
emollient laxative: docusate
osmotic laxative: lactulose, peg
stimulant: senokot, bisacodyl

43
Q

definition of diarrhea

A

Stomach bloating and cramps
Urgent feeling that need bowel movement
Thin/ loose stool, watery

44
Q

Causes of acute diarrhea

A

Infection (Norwalk virus, e coli salmonella)
Diverticulitis
Laxative abuse
IBD
IBS
Lactose deficient
Drugs / toxin
food intolerance

45
Q

Lab test for acute diarrhea? why it is done?

A

Stool culture
CBC
Stool analysis (mucus, fat)
Stool volume analysis

done to differentiate osmotic or secretory diarrhea

46
Q

Lab test for chronic diarrhea? done sbb?

A

same as acute
colonoscopy, biopsy if blood present

done to differentiate it is inflammatory, watery or fatty

47
Q

Non pharmaco treatment diarrhea

A

Fluid replacement
ORS
Diet modify

48
Q

Pharmaco treatment of diarrhea

A

loperamide hcl
lomotil hcl
probiotics
antiinfective (if traveelr’s diarrhea)

49
Q

Pharmaco treatment of diarrhea for acute and chronic diarrhea

A

Attapulgite
Loperamide
Diphenoxylate / atropine

50
Q

Pharmaco trmnt for chronic diarrhea

A

Calcium polycarbophil

51
Q

Pharmaco treatment for travele’s diarrhead / non specific acute diarrhea?

A

Bismulth subsalicylate

CT (1 decks)

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